You may have heard the phrase “children are not little adults”, and this is particularly true in young, growing athletes. Children and adolescents put their bodies through an increasing list of school and sporting commitments, all while their bodies are under the stress of growing.
Young bodies grow rapidly due to the existence of epiphyseal growth plates within bones. During growth spurts, these highly active growth plates are susceptible to becoming inflamed or irritated, particularly where they experience frequent pulling forces from large muscle groups during sport 1. These muscles also become tightened as the bones they attach to grow, further pulling and stressing their bony attachments. Termed a ‘traction apophysitis’, common sites where this occurs include the attachment of your quadricep muscles at your knee (Osgood-Schlatters disease) and your calf muscles at your heel (Sever’s disease) 7.
While these conditions resolve over time as growing slows, it can be highly painful and frustrating for the athlete. So how can a 12-year-old athlete manage the demands of school, club and representative sport, multiple times a week, while also managing their pain?
Settling the Pain
A number of strategies may be implemented to manage pain and inflammation:
• Ice the area for 10 minutes post-activity.
• Anti-inflammatory medications or gels, as guided by your health professional.
• Offloading the area, using taping or heel lifts as prescribed by a health professional, may ease symptoms during sporting activities 4.
Stretch & Strengthen
Shortened muscles are common due to the difference in growth rate between bones and muscles. Regular stretching of large muscle groups – including quadriceps, hamstrings and calves – is helpful in alleviating muscle tightness. This limits pulling forces on sites of growth during activity, and improves force absorption on hard playing surfaces.
Stronger young athletes demonstrate improvements in sports performance, reduced injury risk and greater resilience to the demands of training and competition 6. This is achieved through targeted strengthening of key muscle groups, which may reduce excessive load on overworked muscles. With appropriate programming and supervision, this helps to create a more durable, pain-free athlete.
It may also be important to improve the technique of key movements such as squatting, lunging, jumping and running to prevent the vicious cycle of poor biomechanics continually aggravating the condition.
It is important to educate young athletes to listen to their bodies and the presence of pain. Early signs of overuse, including fatigue and a decrease in performance, should be monitored 8. Where the athlete is experiencing pain in daily activities or affecting their sports participation, modifications or reductions in sporting activities may be required. The duration, intensity or number of training sessions may be reduced, before gradually restoring training load by no more than 10% per week 5.
Pain or injury should be assessed by a health professional to ensure an accurate diagnosis 2. PhysioHealth physiotherapists are experienced in managing young, growing athletes, where ongoing collaboration with the athlete, their coach and their parents in the key to keeping them on the sporting field.
References 1. Chang, G.H., Paz, D.A., Dwek, J.R, & Chung, C.B. (2013). Lower extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment. Clinical Imaging, 37(5), 836-846. 2. Elengard, T., Karlsson, J., & Silbernagel, K.G. (2010). Aspects of treatment for posterior heel pain in young athletes. Open Access J Sports Med, 1, 223-232. 3. Franciscan Health. (2019). Osgood-Schlatter Disease Treatment. Retrieved from https://www.franciscanhealth.org/health-care-services/osgood-schlatter-disease-treatment-604. 4. Howard, R. (2014). Diagnosing and treating Sever’s disease in children. Emergency Nurse, 22(5), 28-30. 5. Launay, F. (2015). Sports-related overuse injuries in children. Orthopaedics & Traumatology: Surgery & Research, 101(1), S139-S147. 6. Lloyd, R.S., Faigenbaum, A.D., Stone, M.H., Oliver, J.L., Jeffreys, I., … & Myer, G.D. (2014). Position statement on youth resistance training: the 2014 International Consensus. British Journal of Sports Medicine, 48, 498-505. 7. Naaktgeboren, K.M., Dorgo, S., & Boyle, J.B. (2017). Growth Plate Injuries in Children in Sports: A Review of Sever’s Disease. Strength and Conditioning Journal, 39(2), 59-68. 8. Valvovich McLeod, T.C., Decoster, L.C., Loud, K.J., Micheli, L.J., Parker, J.T., … & White, M.S. (2011). National Athletic Trainers’ Association Position Statement: Prevention of Pediatric Overuse Injuries. Journal of Athletic Training, 46(2), 206-220.